Acute Superior Mesenteric Artery Occlusion – Combined Treatment Strategy

Abstract

Background

Acute occlusion of the proximal superior mesenteric artery is still a life-threatening disease. Different surgical and endovascular treatment strategies exist.

Methods

The technical and clinical outcome of first line endovascular treatment of proximal superior mesenteric artery occlusion in an academic teaching hospital was evaluated. Endovascular treatment included angioplasty, stent, lysis and/or aspiration and was performed on 38 patients (median age 78 years, range 44 to 88 years). These represent the study population. They presented with abdominal pain or other peritoneal signs. Technical success was defined as revascularization of the superior mesenteric artery with residual stenosis of not more than 30 % and reperfusion of the entire bowel. Clinical success was staged into initial cure, need for second line operation and resection of bowel or death of the patient.

Results

Complete endovascular technical success was reached in 37 of 38 patients. Laparotomy and additional bowel resection was necessary only in a minority of patients. Mortality after 30 days was 45 %.

Conclusion

Endovascular treatment of acute occlusion of the proximal superior mesenteric artery continues to be the promising first line treatment option with a high potential for primary technical success and clinical benefit.